The next few weeks flew by in a flurry of activity, filled with meetings, rehearsals, and promotional appearances. Before I knew it, it was the middle of May, and the Boys and I were just one week away from the start of our world tour, which was set to kick off in Beijing the following weekend. We were now calling it the In a World Like This Tour, named for the title track and newly-selected first single from our new album.
Our last rehearsal in L.A. fell on Saturday, May eighteenth, which was also the fourteenth anniversary of the release of our most famous album, Millennium. I thought about that as we finished with our encore, “Larger Than Life.” It had been the opener of our Into the Millennium Tour, the first song we had performed after floating over the audience on our flying surfboards to the stage, where we’d been backed by a troupe of dancers and a full band. Compared to the over-the-top spectacle of that tour, our current stage set-up felt very simple. No band. No back-up dancers. No surfboards. Just the five of us and a wheelchair.
Yet, as we held our final poses, our last notes still ringing through the rehearsal room, I felt proud of what we had accomplished over the past month. We had put together another entertaining show, one that our fans were sure to love. But, more than that, I was proud of myself for making it this far. I had mastered my modified choreography, memorized our new song lyrics, and manifested what had once felt like a fantasy into a reality. Against all odds, I had become a Backstreet Boy again, and, in one week, I would be back onstage, performing my first full concert in over seven years – and in my new body.
That was the plan, anyway. But, as I knew better than most people, life doesn’t always go according to plan.
At the end of the rehearsal, I said goodbye to the other guys before we went our separate ways, expecting to reconvene in Beijing the following Wednesday. AJ, Nick, Brian, and I would all be flying there from Los Angeles, but Howie was heading home to Florida first to spend a few days with his family before he left for China.
“I feel like I’ve already missed so much of Holden’s life,” he told me regretfully as he drove my van straight from the rehearsal studio to the airport, where I would drop him off and pick up Dawn, who was flying in from Lexington that same night. “Leigh sent me a video of him laughing the other day. I don’t remember James laughing like that at only three months old. Of course, he was a preemie, so he was late to hit most of his milestones…”
As I listened to Howie talk about his boys, I thought of my own son. Mason was also growing up fast, and, like Howie, I felt guilty for being gone so much in the last few months. I had signed Mason up for a spring youth soccer program, but because of my busy rehearsal schedule, I’d barely gotten to see him play. It would be the same way with flag football in the fall; the season overlapped with the dates for the first U.S. leg of our tour, which had gone on sale to the public the previous day. I was grateful to have people I could count on to take Mason to all the practices and games I had to miss, but I would have much rather been there myself.
Even now, I wondered if I was making a mistake in not flying home to see my family like Howie was. But, after talking it over with Dawn, I had decided that it didn’t make sense for me to spend my two days off traveling to and from Lexington, which had no direct flights in or out of L.A. or Beijing. As much as I missed Mason, I knew I would need that time to rest up and pack for our three-week trip to China.
As traffic slowed to a crawl on the freeway, Howie stopped talking so he could concentrate on the road. Taking advantage of the quiet, I closed my eyes and leaned back in my chair, hoping I could catch a few winks on the way to LAX. I couldn’t wait to go to bed when I got home from picking up Dawn, whose flight wasn’t due to land until almost nine p.m. It was just after eight now, but after a long day of sitting up in my chair, I was almost always ready to lie down by nightfall.
Rehearsing all day, every day except Sunday, for the last three weeks had really done a number on my body. My shoulders were sore from pushing my wheelchair around, which seemed to have worsened my nerve pain and spasms as well – and, that night, I also had a pounding headache. I rubbed my temples with the heels of my hands in hopes of relieving it, telling myself it was probably just from listening to our loud backing tracks. But, in the back of my mind, I worried it was more than that. My nose felt stuffy, too; I hoped I wasn’t coming down with a cold a week before our first show.
It’s just seasonal allergies, I tried to reassure myself. The pollen index is probably high from all the plants that are growing right now. You’re not getting sick. You’re just being paranoid.
But, by the time Howie pulled into a handicapped parking spot at LAX, I was covered in cold sweat, which made me wonder if I was running a fever. I raised my hand to my head, knocking my Kentucky cap askew as I rotated my wrist beneath its brim. I could feel heat radiating from my forehead, yet the back of my neck had broken out in goosebumps.
“You okay, Kevin?” Howie asked, giving me a concerned glance.
“I dunno… I’m kinda clammy all of a sudden,” I admitted, pushing the baseball cap back to wipe the cold sweat from my brow. “I probably just have to pee. I should have done it before we left rehearsal.” I hoped that was all it was, although this felt slightly different from the autonomic dysreflexia symptoms I usually got from a full bladder.
Howie clicked on the interior light and took a closer look at me. “Your face is flushed,” he said, frowning.
“Yeah… AD’ll do that,” I replied, trying to keep my tone casual. “C’mon, let’s just get inside so I can cath.”
Howie helped me out of the van before unloading his luggage from the trunk. As we made our way into the airport, he kept sneaking peeks at me out of the corner of his eye, like he was worried I was suddenly going to collapse or something.
As usual, there were a few paparazzi skulking on the curb outside the terminal. I kept my head down and pulled my cap lower over my eyes, but my wheelchair caught the attention of at least one of them. “Kevin!” he called, coming toward us with a camera in his hands. “Howie, hi! How are you guys doing tonight?”
I ignored him, but Howie was too nice. “Good,” he answered the guy. “I’m going home to see my wife and kids before we go on tour next week.”
“Oh, that’s great! And, hey, congratulations on your star on the Walk of Fame!” the photographer added hastily, his camera flashing in our faces as he followed us to the entrance. “So, how does it feel to be a Backstreet Boy again, Kevin?”
“Incredible,” I replied briefly, pushing my wheels at a brisker pace.
Up ahead, a pair of automatic doors slid open, offering us sanctuary from the paparazzi, whom airport security wouldn’t allow inside. “Have a safe flight, Howie!” I heard the guy with the camera call as we hurried through them.
The blast of cool air that hit me on the way inside felt like heaven on my face. Relieved, I stopped rolling and looked around for the nearest restroom. “Go ahead and check in while I hit the john,” I told Howie, motioning toward the line at the Delta counter. “I’ll meet you outside the men’s room over there when I’m done.”
Howie hesitated. “Are you sure?” he asked, checking his watch. “I can wait a few minutes. My flight doesn’t start boarding for another hour.”
“What for? You wanna watch while I stick a tube up my dick?” I replied facetiously, feeling an odd flicker of satisfaction when I saw his face darken, a dull flush flooding his cheeks. “Don’t worry; I’ll be fine, dawg. Just give me a few minutes.”
Once Howie finally agreed to get in line, I hurried into the bathroom. Normally, I felt better almost immediately after emptying my bladder, but not that time. In the ten minutes it took me to relieve myself, the pounding in my head diminished to a dull throb, but none of my other symptoms subsided. I still felt clammy and congested when I left the stall. Stopping at the sink to wash my hands, I cringed when I caught sight of my reflection in the mirror. My blotchy face resembled Nick’s favorite sweatpants by the end of rehearsal, bright red and soaked with sweat. I wet a paper towel and wiped my face with it, hoping the cold water would help to cool me down.
Howie was waiting for me outside the bathroom. “The line wasn’t too bad this time of night,” he told me. “You feeling any better?”
I shrugged. “Not really. I dunno if it’s AD or if I’m getting sick.”
He frowned. “Well, I hope you’re not getting sick. What else could be causing AD?”
“Could be anything…” I ran through a mental checklist, racking my brain for other possibilities. If it wasn’t my bladder, maybe it was my bowels. But, no, probably not – Howie had done my bowel program that morning, and I had been too busy with rehearsal to eat much during the day, so that didn’t make sense. Tight-fitting clothing? I was wearing stretchy athletic shorts and a t-shirt, so that couldn’t be it either. Skin breakdown? I couldn’t exactly check while I was seated in my wheelchair, but I shifted my weight, trying to take some of the pressure off of my sitting bones.
That seemed to help. Within a few minutes, my fiery face had cooled down, and my stuffy nose had cleared. I inhaled a grateful breath through my nostrils and let it out gradually, feeling calmer than I had before. I must have simply been sitting in the same position for too long.
“I think I’m all right now,” I told Howie, who had been anxiously waiting with me. “You’d better go through security so you can get to your gate before boarding.”
He shook his head. “I still have… almost forty-five minutes,” he said, glancing at his watch again. “I’m not leaving you here alone.”
“Dawn should be here any second now.” I looked up at the arrivals board, which showed that her connecting flight from Atlanta had landed fifteen minutes ago. “Lemme give her a call and see if she’s gotten off the plane yet.”
I leaned over to grab my phone from its pocket on the side of my chair, but before I could fish it out, I heard Howie say, “Wait, there she is! Who’s that with her? Is that…?”
I straightened up to see him pointing toward the escalator, which carried passengers from the gates above to the baggage claim and ticketing counters below. Following his line of sight, I didn’t even notice Dawn coming down it at first. My attention was drawn to the woman in the red dress who stood two steps behind her, clutching the handle of her carry-on.
“Natalie,” I whispered, my heart leaping into my throat.
“What’s she doing here?” Howie wondered aloud. “Doesn’t she live in Atlanta?”
“She must be working,” I replied, my mouth going dry when I realized Natalie was wearing the same uniform she’d had on the day we had first met. A part of me hoped she wouldn’t see me or Howie, but I knew there was no way she hadn’t noticed Dawn standing right in front of her. Sure enough, a second later, she saw us staring and locked eyes with me. Fighting the urge to look away, I formed a thin-lipped smile and received a similar expression in return.
When the escalator flattened into the ground floor, Dawn stepped off and headed straight for Howie and me. To my dismay, Natalie followed her. I swallowed hard, bracing myself to face her for the first time since our break-up almost six weeks ago.
“Hey!” Dawn called a little too brightly, waving as she walked over to us. “Look who I bumped into on my flight!”
“Hi, Howie… Kevin,” Natalie said quietly, flashing an awkward grin that faltered as her gaze landed on me.
“Hey, Natalie!” Howie stepped forward to give her a cursory hug. “It’s good to see you again. How have you been?”
She shrugged. “All right, I guess. How are you guys?”
“Fine,” I answered almost defiantly, glancing down at the floor so she wouldn’t see the truth in my eyes.
“I’m good,” said Howie. “About to head home for a few days before we leave for China. Speaking of which, I’d better get going. My flight starts boarding in about forty minutes, and I still have to go through security.”
“Thanks again for everything, brother,” I said, giving him a grateful hug before he left. “See ya in Beijing.”
Howie said his goodbyes and hurried off, leaving me alone with the two women. Turning my attention to Dawn, I said, “We’d probably better get going, too. I’m pretty tired, and you’ve gotta be dead on your feet, considering it’s past midnight in Kentucky.”
“I took a nap on the plane, so I’m not too tired,” Dawn replied with a shrug. “Besides, we still have to wait for my checked bag.”
“Oh. Right.” I felt my face redden, knowing Natalie would see right through my attempt to escape the awkward situation. I had expected Dawn to go along with it, but, for some reason, she seemed almost determined to make things even more awkward for us.
“Carousel six, right?” Dawn said to Natalie, who nodded.
“Can I walk with you?” she asked me, sounding hesitant. “I have about an hour to kill before I have to report for duty. I’m working a red-eye to Seoul tonight.”
A hard lump rose in my throat as I recalled her FaceTiming me from Seoul last summer, when our relationship still felt fresh and new. We had only been on a few dates, but, already, we were falling in love. Looking at her in her red dress, it was easy for me to remember why I had been so drawn to her in the first place – and hard not to have regrets. “Of course,” I responded, clearing my throat to get rid of the lump. “So, I take it you had to commute here from Atlanta?”
“Uh-huh. It was either that or look for a crash pad in L.A., since I had planned on being based here this month,” she said, giving me a sidelong glance as we made our way to the baggage claim area.
I felt a little stab of guilt, knowing I was to blame for this inconvenience. Natalie had arranged her whole work schedule around mine, specifically bidding on flights out of L.A. so that we could still see each other regularly while I was rehearsing there. “That sucks. I’m sorry,” I said, hoping I sounded sincere. “I didn’t think about that before… before we broke up.”
“Before you dumped me, you mean,” she replied bluntly. “Let’s not mince words here, Kevin – because it’s not like I wanted to break up with you.” Behind her, I saw Dawn raise her eyebrows and bite her lip, as if trying to hold back a laugh.
“Fair enough,” I said with a nod, wanting to avoid another argument. “I didn’t think about that before I dumped you. If it helps, I also didn’t think about who was gonna do my care while I was out here – not that I would have kept you around just for that reason.” I saw her eyes narrow and realized I was just making it worse. “Anyway… sorry,” I finished quickly.
To my relief, her face relaxed into a rueful smile. “I’m sorry, too, for the way I reacted when you got home from Vegas. I said some things that I regret. That’s really why I followed Dawn down here to see you,” she said, glancing back at Dawn. “I’m glad we got a chance to chat and… you know… clear the air.”
I followed her gaze to Dawn, wondering what the two of them had talked about without me around. Dawn wore a neutral expression, her face betraying nothing. I couldn’t wait to get back to the car and hear what she had to say.
As we approached the baggage carousel, it sprang to life and started spitting out suitcases. Dawn moved closer to look for her luggage while Natalie and I hung back out of the way.
“So, how have you been?” I asked her as we waited.
“Oh, you know… trying to stay busy…” She trailed off, twirling the end of her long, brown ponytail around her finger.
“Same here,” I said. “I’ve been rehearsing with the boys six days a week, trying to get ready for the first leg of our tour. We leave for China on Tuesday.”
Natalie nodded. “I saw you guys on Good Morning America the other day. You sounded really good. I like your new song.”
“Thanks.” I pasted a polite smile onto my face, hoping it would help to hide the pain in my heart. Natalie didn’t need to know that I had thought of her every time we’d sung “Permanent Stain” over the past week; it would only make it harder for her to move on from me.
“You’re welcome,” she replied, smiling back at me. “I can’t wait to see the whole show. Jared and I just got tickets for Atlanta in August.”
“Really?” I said, blinking in surprise. “You didn’t have to buy tickets. I could have comped you some if I’d known you wanted to come.”
“That’s kind of you to offer, but I wouldn’t wanna give anyone another reason to think I was just taking advantage of you. It would be different if we were still dating, but since we’re not…” Natalie shrugged. “I can afford my own tickets.”
I frowned. “What are you talking about? Who thinks you were taking advantage of me?”
“Oh, just a few of your fans on Twitter,” she said with a breezy sigh. “There was a lot of talk after your twentieth anniversary last month. People noticed that I wasn’t at any of the events and that you didn’t mention me in your speech at the Walk of Fame ceremony. Congratulations on the star, by the way.”
“Thanks,” I said, still frowning. “So they figured out that we broke up, just from that?”
Natalie nodded. “And, of course, there was a very vocal minority that assumed it must have been all my fault because you’re obviously a perfect human being who couldn’t possibly be guilty of any wrongdoing,” she continued, her voice dripping with sarcasm. “You must have finally realized that I was a gold digger who was just using you for clout, like they thought all along.” She rolled her eyes and shook her head, acting as if she found the whole thing ridiculous. But, in spite of her flippant tone, her reddening face told me she was more bothered by my fans’ harsh judgment of her than she wanted to admit.
“I’m sorry, Natalie,” I said quietly. “The people who actually knew us as a couple know that’s not true. I can post something on Twitter to tell the fans it’s not true, too.”
“Don’t bother,” she said with a dismissive wave of her hand. “You’d just be drawing more attention to the drama. It’s already died down some since April; addressing it now would only give it new life.”
I nodded, knowing she was probably right. “I had no idea it was even happening,” I replied apologetically. “I’ve been so busy lately, I’ve hardly been online.”
“It’s okay,” she said, shrugging. “I’m not blaming you. It’s natural for fangirls to feel protective of their favorites, especially when they’ve been through as much as you have. But that’s not your fault.”
I knew I wasn’t to blame for my fans’ behavior, but I still felt bad about it. By the time Dawn walked back over to us, I felt even worse – but not because of what Natalie had told me. My headache was back, and so were the hot flashes and cold chills I’d had before using the bathroom. I shifted my weight again, hoping it would help ward off the threat of AD like it had earlier.
“Nice suitcase,” said Natalie, noticing the brand new, navy blue Rimowa suitcase Dawn was wheeling next to her. With a hard exterior made of lightweight aluminum and four spinner wheels, it moved effortlessly at her side.
“Thanks!” Dawn said, glancing down at it with a smile. “It was a birthday gift from Kevin. He thought I could use some better luggage for when we go on tour.” Dawn had no idea just how much the high-end suitcase had cost, but I could tell by the way Natalie raised her eyebrows that she knew. As an experienced traveler, she must have recognized the luxury brand almost immediately.
I felt my face redden as both women looked my way, although I wasn’t sure whether it was the result of my physical or mental discomfort. The expression on Natalie’s face reminded me strongly of her sister’s. “That purse alone probably cost over a thousand dollars!” I recalled hearing Mindy hiss to her mother after Natalie had opened her birthday presents from me in front of her family. I supposed giving Dawn an equally expensive gift had only reinforced Natalie’s suspicions about the nature of our relationship. Indeed, it was with a distinctly frosty tone that she wished Dawn a belated happy birthday.
But if Dawn noticed the sudden shift in Natalie’s demeanor, she pretended not to. “Thanks!” she replied brightly. “I didn’t think I would be happy about turning forty-seven, but ever since my health scare back in February, I’ve just been grateful for every good day I get. Growing old is a gift not everyone gets to experience, you know?”
Natalie nodded, her cheeks taking on a pink tinge. “I’m glad you’re doing well,” she told Dawn in a slightly warmer tone. “It was good to see you again. Both of you.” Her gaze drifted from Dawn back to me. “I should probably go now, so I can grab a bite to eat before my next flight.”
“Have a safe flight,” I told her as she bent down to give me a quick hug. There was so much more I wanted to say, but my breath caught in my throat as I watched her walk away, her ponytail swishing back and forth between her shoulder blades like a pendulum. I could practically hear it ticking in time with the clicking of her heels across the tiled floor – but, as the sound of her footsteps faded away, it occurred to me that what I was actually hearing was my own pulse pounding inside my head.
I didn’t mention my worsening headache on the way home, worried that Dawn would drive me straight to the hospital instead if she knew I’d been dealing with recurrent AD since Howie and I had left rehearsal. Despite the risks of letting my blood pressure rise to a dangerously high level, I didn’t want to spend the rest of the night being poked and prodded by a bunch of nurses and doctors. I just wanted to go home and relax. You’ll be okay once you get out of your wheelchair, I kept telling myself as I shifted my weight from side to side, forward and back. Each change in position seemed to temporarily relieve the pressure building inside my head, just as it reduced the pressure on the paralyzed parts of my body. But these brief windows of time in which I felt better were becoming shorter, and it wasn’t long before Dawn noticed.
“Why are you so fidgety tonight?” she asked, frowning in my direction once she’d finished merging onto the freeway. The heavy traffic from earlier had thinned out, leaving the five lanes ahead of us mostly clear.
“I’m just tired,” I said, counting on the darkness to hide the beads of sweat that were dripping slowly down the sides of my face. “Been sitting in this damn chair for way too long today. I can’t wait to get home and transfer into bed.”
“I hear ya,” she replied, nodding. “I couldn’t wait to get off that plane and stretch my legs. Not looking forward to the fourteen-hour flight to China.”
“Me neither.” I cleared my throat. “Speaking of which… How was it running into Natalie on the way here?”
“A little awkward at first,” Dawn admitted, “but we ended up having a nice conversation.”
“What’d you talk about?”
“You, mostly.” Her lips twitched, their corners curving into a tiny smile. “Not like we have much else in common.”
That was what I was afraid of. “So, what’d you say about me?”
“She asked how you were doing. I told her you seemed pretty depressed right after the break-up, but that you’d been staying busy with rehearsal since then.” Dawn gave me a sidelong glance. “I hope you didn’t expect me to lie to her.”
I sighed. “No, of course not.”
“Good, ‘cause I don’t play games like that.” She paused. “I also told her what happened – and what didn’t happen – in Vegas. I know you already told her the whole story, but I wanted her to hear it from me.”
I looked curiously at her. “How did that go?”
“Not bad. Like I said, we had a nice conversation – one I wish we could have had before you broke up with her,” said Dawn with just a touch of snark in her tone. “I took the blame for my bad decisions that night, told her you were just trying to take care of me, and apologized for falling asleep in your bed. She admitted that the reason she overreacted to our sleeping arrangement was that my relationship with you always made her feel insecure about hers. So then, I had to reassure her that nothing happened between you and me and that our relationship has never been even remotely romantic.”
“I told her that, too, but apparently she didn’t believe me,” I grumbled, shaking my head. “I hope she believed you.”
“I think she did – and I think she believed you, too,” said Dawn. “It’s not about that. She knows we’re just friends. But, honestly, I think that’s what she’s jealous of.”
“What? Our friendship?”
“Yeah… because you and Natalie never were ‘just friends.’ Y’all skipped right over that phase and jumped straight into a romantic relationship. And, now that it’s ended, there’s a part of her that regrets not getting to know you as a friend first,” Dawn reasoned, “because if she’s not your girlfriend anymore and can’t consider herself your friend either, then she’s nothing to you. You don’t need her anymore. She’s no longer an important part of your life.”
“That’s not true,” I said quietly. “She’s not ‘nothing’ to me.”
“I know. I’m just saying, that’s how she sees it – and that’s what hurts her the most.”
As Dawn fell silent, focusing on the dark stretch of road in front of us, I thought about what she’d said. In my mind’s eye, I saw Natalie’s brown eyes swimming with tears as I told her why I was breaking up with her. “You made it pretty clear to me last night that you can’t keep living under the same roof as Dawn. But Mason and I need her here.”
“More than you need me?” her plaintive voice echoed inside my head.
At the same time, I heard Dawn telling me, “A lot of chicks dig a dude who’s vulnerable in some way. It feeds their nurturing instinct, you know? They want someone they can take care of.”
Maybe she was right. Maybe Natalie just wanted to be needed again. I certainly knew that feeling. But it was supplanted by a sense of impending doom as the pressure built up inside my skull, the pounding of my pulse hammering heavily against my eardrums with each heartbeat making it impossible for me to focus on anything else.
“Can you please drive faster?” I begged Dawn, leaning forward to take the pressure off my tailbone. I couldn’t tell for sure what part of my body was in pain, but I was becoming increasingly convinced that my worsening autonomic dysreflexia had been caused by some kind of discomfort in that area. “I need to get home and out of this chair now.” I kept my voice low and calm, not wanting to alarm her while she was behind the wheel, but I knew my words would naturally cause some level of concern.
“Of course.” Dawn gave me a disconcerted glance as she pushed her foot down on the accelerator. “Are you okay?” Before I could reply, she reached out and pressed the palm of her right hand to my forehead, just as I’d seen her do to Mason when he was running a fever. “You’re not, are you?” She answered her own question as she moved her hand around to the back of my neck, sending shivers down my spine. “You’re all sweaty,” she observed, wiping her hand off on her pants.
“I know. I’ve been having hot flashes and headaches off and on for the past hour or so,” I admitted. “I already peed at the airport, and Howie did my program this morning, so I don’t think it’s a bladder or bowel problem. I didn’t fall out of my chair or drop anything heavy on my foot, so I doubt it’s an injury either. It’s probably just a positional thing.”
“I hope you don’t have a pressure sore,” Dawn replied, frowning. “Should we pull over somewhere and try transferring you to the back seat?”
I looked out the window at a green road sign for the next exit onto Wilshire Boulevard. We were halfway back to my house. “Nah – too much hassle,” I said, shaking my head. “Just take me home, so I can get into bed.” I held my breath, anticipating an argument as we approached a blue sign that directed drivers to take the exit in order to reach the nearest hospital. But if Dawn noticed it, too, she didn’t acknowledge it and remained in the center lane of the freeway. I released my breath in a sigh of relief as we sped past the exit.
By the time we pulled into the driveway, I was drenched with sweat, and my head hurt so badly that I could hardly see straight. My vision had begun to blur, which made it more difficult for me to wheel myself down the van’s ramp and up to the front door. It took me two tries to punch in the correct code to unlock it; the numbers on the keypad kept swimming before my eyes. Dawn held the door open for me, then followed me inside as I made a beeline for the master bedroom.
“How are you feeling?” she asked as she reached for my sliding board.
“Bad,” I answered breathlessly as I parked my chair beside my bed. I didn’t elaborate, and Dawn didn’t press me for details, wedging the wooden board under my butt without another word. I leaned heavily on her as she hauled me across it, trying to avoid being kicked by my spasming legs.
By the time I flopped backward onto the bed, we were both breathing hard. I lay flat on my back, frantically sucking lungfuls of air through my mouth because my nose felt stuffy again. I could hear Dawn huffing and puffing as she hurriedly undressed my bottom half. As she removed each piece of clothing, she quickly examined the part of my body it had covered to check for obvious signs of injury or infection, keeping a running commentary as she poked and prodded me so I could tell what she was touching without watching her at work.
“Your feet look fine,” she said after sliding off my shoes and socks. “I don’t see any ingrown toenails, blisters, bruises, or swollen spots.” Next, she took off my shorts and felt both legs, lifting and bending to look at them from all angles. Again, nothing seemed to be wrong. It was only once she removed my underwear and rolled me onto my belly that I heard her gasp.
“What is it?” I asked in a low voice, afraid to hear the answer. “A pressure sore?”
“Uh-huh. Right at the base of your left butt cheek.”
My heart sank. “How big?” What I really wanted to know was, How bad?
“About nickel-sized.”
I had her snap a photo of it with my phone, so I could see for myself. It took my bleary eyes a few seconds to adjust, but even before the image came fully into focus, the round, red sore stood out against the pale white skin on that part of my body. It looked like a blister, but I knew it was more serious than that.
“The problem with pressure injuries is that they’re like icebergs,” one of my former caregivers, a nurse named Greg, had once explained to me. “The sore itself is only the tip. By the time you see breakdown on the surface of the skin, there’s been a lot more damage done to the tissue underneath. That’s when they can become serious and slow to heal.”
One of the first things I had learned as a quadriplegic was the importance of preventing pressure injuries, which I’d been told would set back my progress by weeks, possibly even months. That was why I had always been so diligent about being repositioned in bed at night, even when it interrupted my sleep, and performing frequent weight shifts during the day, when I was in my wheelchair. I’d never had problems with skin breakdown before, so even now, as I stared down at the photo of what was obviously an open wound, I still felt a certain level of denial.
How could this have happened? I wondered, my mind racing beneath the marching drumbeat inside my head. Had I gotten distracted and forgotten to shift my weight often enough during rehearsal, or had I simply been sitting in my chair for too long?
“Kevin?” Dawn’s voice cut through the cacophony, causing my heart to skip a beat.
“Yeah, that looks like a pressure sore, all right,” I said, setting the phone down with a sigh. “Not that I’m an expert. I’ve never had one before – not like this, anyway.”
“I’m no expert either, but I’ve seen these before. Michael got one over his tailbone once – I felt terrible! But, by then, most of his muscle tissue had atrophied to the point that he had no natural padding left, so it was hard to prevent them. He was nothing but skin and bone toward the end…” She trailed off, then cleared her throat, snapping back into caregiver mode. “Anyway, the most important thing is to keep the pressure off of that area, so we’d better leave you on your belly for as long as you can tolerate it. Are you feeling any better yet?”
“I dunno… not really…” My vision had cleared, but I still had a horrible headache.
“We should check your BP.” Dawn fetched my blood pressure monitor from the bathroom. “I don’t know how accurate the reading will be with you lying like this, but at least we can watch for it to come down,” she said as she wrapped the cuff around my left arm.
I lay perfectly still as the cuff inflated, knowing it was important to stay calm and quiet while the monitor collected its data, but inside, my thoughts were running wild. How long would this wound take to heal? What if it prevented me from being able to sit in my wheelchair? How would I perform?
Before I could spiral into a full-blown panic, the monitor beeped, providing a momentary distraction. “180 over 103.” Dawn let out a disapproving sigh as she looked at its reading. “That’s dangerously high, Kevin. Why didn’t you say something sooner? We could have gone to the hospital instead of home.”
“Because I didn’t want to go to the hospital,” I admitted, knowing she would understand. “Just give it a few minutes. It’ll come down. You said it might not be accurate anyway.”
“That’s what scares me,” she said, frowning. “What if it’s actually higher?”
“It’s been higher than this before,” I told her, trying to sound nonchalant as I remembered that night with Natalie in Jamaica. “Much higher. But it came back down, and I didn’t stroke out.”
“You were lucky,” said Dawn. “But I’d rather not rely on luck.”
“How about nitro paste?” I replied before she could suggest calling 911. “I have some in the bathroom.” I had just remembered that Dr. Collins had written me a prescription for the topical ointment to take with me on tour, in case I developed severe AD while I was overseas. Even in the United States, some doctors and nurses had never even heard of autonomic dysreflexia; a language barrier would make it even harder to explain the condition to a foreign medical team.
“Good. I’ll go grab it. You take some deep breaths and try to relax.” Dawn rubbed my back reassuringly before she disappeared into the bathroom.
I tried to follow her directions but found it difficult to breathe deeply while I was lying on my belly with my chest pressed into the mattress pad. It was even harder to relax when my head was pounding, my mind racing.
Thankfully, Dawn returned less than a minute later with a small white box, which contained a tube of nitroglycerin paste and the paper squares that were used to apply it. She rolled me onto my right side, removed my t-shirt, and put on a pair of gloves before carefully squeezing a line of the ointment onto one of the squares of paper, which was marked with measurements to show her how much to use. She placed it on my bare chest, just above my level of injury, securing it with two pieces of medical tape. “There. Let’s give that a few minutes to kick in before we check your BP again,” she said as she peeled off her gloves.
While we waited, she wet a washcloth and wiped the sweat off my face. It felt cool and refreshing on my flushed skin. Within a few minutes, my hot flash had subsided, and when Dawn took a second blood pressure reading, my numbers had dropped to a far less dangerous level.
“That’s more like it,” she said with a sigh of relief as she removed the cuff from around my arm. “We should check it one more time in ten minutes or so to make sure it’s gone back to your baseline. Then we can take off this nitro patch.”
I nodded. “Can you pull the covers up over me?” I asked her. I didn’t care about being naked in front of Dawn, but now that I was no longer burning up, I felt freezing cold without my clothes on.
“Yep, in a second. Don’t want you getting pressure sores anywhere else.” She wedged a pair of pillows between my knees and ankles to alleviate the pressure there. “Speaking of which, we probably shouldn’t leave this wound uncovered,” she said, leaning in to take another look at the sore on my backside, “but I don’t think we have the supplies we need to dress it properly.”
“Can’t you just cover it with a Band-Aid or something?” I asked through chattering teeth, wishing she would hurry.
Dawn shook her head. “When I worked at the nursing home, we would sometimes get new residents transferred in from other facilities or home care who had bedsores. We always used a saline rinse to clean wounds like this one, and then we would cover them with a special type of dressing that wouldn’t stick to the wound or cause more skin breakdown,” she explained as she draped my top sheet and comforter loosely over my body. “I can run to Walgreens and pick up some supplies to get you through the night, but you’d better plan on calling your doctor first thing tomorrow morning.”
“On a Sunday? What doctor’s office is open on Sunday mornings?”
“Well, shit.” Dawn sighed. “Didn’t think about that. Make that Monday morning, then.”
“I wouldn’t know who to call anyway,” I added with a shrug. I had several different doctors back in Kentucky, but it had been years since I’d seen one in California. “I guess I could start with the rehab hospital I went to and see if they could refer me to someone…”
“That’s not a bad idea. In the meantime, I can take you to urgent care tomorrow. Most of them are open on Sundays. If they can’t treat it there, they can at least tell you who to call.”
“Maybe it’ll be better by tomorrow,” I said hopefully.
“Maybe.” Dawn didn’t sound too optimistic. “Anyway, let’s not worry about that now; we don’t want your blood pressure creeping back up,” she said, flashing me a crooked smile. “How ya feeling?”
“A little better.” I still had a headache, but that might have been from the medication making my blood pressure plummet. At least it was no longer throbbing like it had been before.
“Good.” She gave me a pat on the shoulder. “I’m gonna go drop off my luggage and freshen up a little. I’ll be back to check on you in a few minutes, but holler if anything changes in the meantime, okay?”
She must have been tired, but I could tell she was hesitant to leave me alone. Offering her a reassuring smile, I nodded and said, “I’m all right. Take your time.”
But as soon as she left, I felt my smile fade. Picking up my phone again, I studied the photo she had taken of the pressure sore located right over my left sitting bone. I didn’t need a doctor to tell me what I already knew: This small, seemingly innocuous blister was going to be a big problem.
It looked like my plans were about to be put on hold.
***